| NPI | 1700822913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M1422) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX M1422) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP456) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2016-11-30 |